Aid to care during COVID for the elderly
Tata Trusts has supported state governments of Maharashtra, Karnataka & Telangana for elderly care, says Dr Shrikant Kalaskar
COVID-19 is one such devastating diseases which is having severe outcomes primarily in people with age more than 60 years and suffering from comorbidities like hypertension, diabetes, cardio-vascular disease etc. As per the Census of India 2011, 8.3% of the total Indian population was aged 60 years & above, and out of this 71% live in rural India. So, a very large chunk of population of elderly lives in rural India. Many studies have shown that, diseases such as hypertension and diabetes remain undiagnosed for longer durations as they don’t show major symptoms.
Given low literacy rates in rural elderly, health seeking behaviour and difficulty in accessing health care makes it even more difficult to diagnose and control these conditions in them. Combination of old age, comorbid condition and COVID makes rural elderly population more vulnerable for severe outcome if at all they get infected. It implies that rural elderly is at very high risk of mortality due to COVID-19.
According to Centers for Disease Control and Prevention, Atlanta, USA ‘8 out of 10 deaths reported in the U.S. have been in adults 65 years old and older’. Total 5000 deaths happened in India due to COVID-19 till 30th May out of which more than 50% deaths were reported in elderly and 73% were having one or more comorbidity. According to a study there are less than 10% of cases in elderly age group contributing to more than 52% of total deaths in India till 20th May, which clearly indicates high risk of elderly people to COVID-19.
For addressing health care needs of elderly, the Government of India had formulated a National Programme for Health care of Elderly (NPHCE) in 2011 and issued necessary operational guidelines. As Health Ministry and the states are more focused on strengthening district level health facilities by establishing separate ward for elderly and conducting daily OPD, the NPHCE programme is doing well at the district level. But, because there is no additional manpower for this programme below district level, very few states or districts are following guidelines of the programme or implementing it at PHC and CHC level.
To bring the attention back to the importance of primary level health care for elderly, Tata Trusts has supported state governments of Maharashtra, Karnataka & Telangana (one district in each Chandrapur, Yadgir and Medak respectively) for elderly care. These districts focused on early detection of non-communicable diseases in elderly, spreading awareness about health issues, and improved adherence to the treatment of these diseases by starting weekly dedicated geriatric clinic at PHC level. These three districts have started conducting weekly dedicated geriatric clinic as per the guidelines of NPHCE in 90 PHCs and CHCs. Through Gram Panchayats of these districts, 58 activity centres were started at village level for the elderly to keep them healthy and active. In these centres elderly can participate in various physical activities, recreational activities, awareness sessions on health, nutrition, and, intergenerational bonding for 2-3 hours in a day, for 3-4 days in a week.
These three districts have oriented around 700 health care personnel (Medical officers, ANMs, ASHAs, MLHP/CHO) in elderly care viz., on issues faced by elderly and on conducting comprehensive geriatric assessment. In absence of digital medical information system at primary care level, as per the guidelines of NPHCE, a comprehensive “Health Card” (Medical record) was developed with inputs from Community Medicine department, St. John’s Medical College, Bangalore, state and central government health officials. Around 53700 elderly persons were progressively screened for non-communicable diseases and elements of elderly care and have the health card with them since the last two years (progressively), which are used when they visit PHCs and CHCs. All the medical and surgical history of elderly along with disease profile, blood sugar, blood pressure readings and medication details are noted in the health card over the period.
Since the lockdown phase had started, rural communities have been facing various challenges and more so the elderly in the villages. The health cards turned out to be a ray of hope for the elderly. On enquiry through calls, it was revealed that around 82% of total elderly (6751) called were getting their supply of medicines, rest 18% were helped by the team by guiding them on call to get the medicines. The elderly clearly stated that either they were visiting the health facility on designated day for geriatric OPD or any of their relatives /caretakers such as son/daughter-in-law were visiting and collecting the required medicines. With the health card, Medical officers also found it more convenient to see the history of disease, investigations and medication history, and, they are not hesitating to handover medicines to even the relatives of the elderly.
Health card has shown the pathway for the public health system to monitor, follow up and continue to address the various health conditions of the elderly even in the Covid-19 uncertainties. On other hand, elderly persons also feel that health card helped them get their treatment faster as they don’t have to wait in long queues.
Similar interventions with early diagnosis and maintaining proper health records can help the health system in battling any emergency like COVID-19 in future as well. Health and wellness centres are also supposed to work on the similar lines and cover 12 different components of health apart from six traditional ones. Elderly care is one of the twelve components covered under health and wellness centres and the Mid-Level Health Providers (MLHP) have been appointed after undergoing a six-month course. The MLHPs or Community Health Officers (CHO) who are placed in the sub centres which are upgraded as Health and wellness centres of these districts are also trained in elderly care. They are supposed to visit elderly household regularly in their designated area. Elderly should be managed for diagnosed chronic conditions such as hypertension, diabetes, arthritis etc. in these upgraded health and wellness centres near their village. These types of intervention can keep elderly healthy by managing common non-communicable diseases and help them in battling emerging infections like COVID-19.
Dr Shrikant Kalaskar is Public Health Consultant with Tata Trusts.